This blog post last Friday in the New York Times is about the fact that someone with Medicare can be a patient in the hospital but not be an "admitted patient." The person may actually be in the hospital under "observation." These "observation days" do not count towards the three-day hospital stay required by Medicare to get short-term skilled nursing care that is paid for by Medicare. Surprisingly, according to the article, a hospital can" retroactively change a patient's status from admitted to observed."

_________________Pat [68] married to Derek [84] for 38 years; husband dx PDD/LBD 2005, probably began 2002 or earlier; late stage and in a SNF as of January 2011. Hospitalized 11/2/2013 and discharged to home Hospice. Passed away at home on 11/9/2013.

Thu Jun 28, 2012 1:23 am

PBiever

Joined: Sat Sep 03, 2011 2:36 pmPosts: 10

Re: "In the Hospital, but Not Really a Patient"

Hi,This happened to my Dad in 2008 when he had not yet been diagnosed with Lewy. He had some behavior issues at his assisted living facility and we took him to a psychiatrist who prescribed Abilify. After about two weeks he declined to the point where he ended up in the ER and was hospitalized for 5 days. On the 5th day, I found out from a social worker that he was was officially a patient but was considered under observation status. To make a very long story shorter, Dad ended up in a nursing home for six weeks and this was not covered by medicare because he wasn't a "real patient" I appealed his case, got hospital records and supporting letters from his doctor and from other doctors who diagnosed what was wrong with Dad - a reaction to the Abilify due to LBD. I found out that the social worker had lied to me and that Dad had been admitted as a real patient but that a committee who reviews the cases at the hospital later determined he did not met the criteria of acute care. They could not get Dad's doctor to agree to this decision. All sorts of record problems and rule violations happened as I discovered when reading the hospital records and researching what the medicare requirements are. I won the appeal and received a refund from the nursing home. I had to take the appeal up to the highest level. It was written up in the newspaper at the time. I wonder how many other people suffered as a result of these types of hospital issues - I had the ability to research and determine what to do to dispute it and had a very organized set of documents to submit. But not everyone has the time or resources to do what I did.

Thu Jun 28, 2012 7:13 pm

mockturtle

Joined: Wed Dec 30, 2009 1:46 pmPosts: 3213Location: WA

Re: "In the Hospital, but Not Really a Patient"

And it not only affects nursing home costs but the hospital costs, since Medicare only pays 80% under Medicare B for non-admission hospital care. And hospital costs, as we all know, are through the roof.

_________________Pat [68] married to Derek [84] for 38 years; husband dx PDD/LBD 2005, probably began 2002 or earlier; late stage and in a SNF as of January 2011. Hospitalized 11/2/2013 and discharged to home Hospice. Passed away at home on 11/9/2013.

Just won a battle with a hospital that tried to charge for the emergency room visit. Our HMO contract clearly states that the charge is rescinded if the patient is admitted upstairs to a room. Their defense was "the Dr. coded it wrong" (@ 11:00 PM after many, many trying hours). They said it was incumbent upon me to seek out the phantom Dr. and make sure he does not code it as "observation" They said it could not be changed and sent it to a collection agency only six weeks after the ER visit.The whole thing sounded preposterous. Now I know why they staged this scenario..I thought it was to bilk me out of the measly $65, but it is a much larger planned plot.Forewarned is forearmed. Weary or not, I'll keep it in mind if there should be (I hope not) another trip to the ER.

_________________Age 78 married 59 years last January to Bernie (age 86).Family concerned & supportive, but too far away to help.

Thu Jul 12, 2012 7:36 pm

irene selak

Joined: Sat Jan 03, 2009 2:59 pmPosts: 1978

Re: "In the Hospital, but Not Really a Patient"

You really have to be on your toes 24/7 with everything nowadays !

_________________Irene Selak

Thu Jul 12, 2012 8:23 pm

RahRah

Joined: Sun Dec 02, 2012 9:01 pmPosts: 6

Re: "In the Hospital, but Not Really a Patient"

This happened to my FIL recently - after my DH took him up to the ER for a suspected knee fracture following a fall a few days earlier, they admitted him, but under observation! It was obvious he was going to need rehab and DH (who is a physician) caught the coding as observation and had to fight, tooth and nail, to get his dad changed to in-patient admission so when he was discharged to a short-term SNF for rehab medicare would pay for the first 20 days and partially for day 21-100. He's now in the 21-100 days in rehab and we're working to get him discharged home soon!

Mon Dec 03, 2012 11:02 am

irene selak

Joined: Sat Jan 03, 2009 2:59 pmPosts: 1978

Re: "In the Hospital, but Not Really a Patient"

RahRah, You are very lucky that your husband caught the incorrect code as many of us wouldn't know the difference !

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